I originally introduced the rainbow model of mental illness functioning last year to capture some of my thoughts on the relationship between symptoms and functioning in mental illness. This is something that exists in my head rather than being an actual thing, and it’s not a model in the scientific sense, but it shows some of the complexity in what I see as the bigger picture of mental illness.
I’ve thought about it more since I initially wrote about it, so I wanted to write more about it. Before getting into the details, here’s a quick overview of the rainbow model:
- It considers symptoms and functioning separately. Symptoms affect functioning, but someone might have severe symptoms in one area but still be able to function in certain areas. Saying someone is “high-functioning” can imply that symptoms aren’t that bad, which isn’t necessarily the case.
- Symptoms and functioning are each split into six domains. These domains are fairly arbitrary, but I’ve tried to generalize the areas of life that mental illness tends to affect. Each gets a different colour of the rainbow, to make it pretty.
- Each symptom and domain is on a spectrum of light to dark, representing more or less severe symptoms and higher or lower functioning. Where we are on each spectrum changes over time depending on how we’re doing. My symptoms might be quite mild in one domain but at the same time quite severe in another domain, and I might function quite well in some domains while doing quite poorly in others. It’s spectrum-based rather than numbers-based because I feel like it’s hard to quantify subjective experiences.
Rainbow model symptom domains
I split symptoms up into six domains based on what they involve rather than specific symptoms to make it fairly applicable across different illnesses.
These are the domains, along with a few different kinds of symptoms that might fit into each, although exactly what might fit into each domain for you would depend on what you experience and how you experience it.
- Emotional: depressed mood, anxiety, guilt, anhedonia
- Cognitive: worry, rumination, obsessions, delusions, overwhelm, impaired concentration/memory
- Perceptual: hallucinations, sensory processing issues
- Disturbed view of self: shame, self-loathing, emptiness, dissociation, distorted body image
- Physical: physical symptoms of anxiety, fatigue, restlessness, psychomotor retardation
- Behavioural: avoidance, freeze response, isolation, compulsions
Each spectrum is shown with pale colours as no/mild symptoms and dark colours as severe symptoms. I’ve stuck in a few arbitrary dark blue markers to show how, at a given point in time, someone might be at different places with each area of symptoms. Over time, each of those markers might slide up or down the spectrum.
How I’m doing
Here’s a look at where I am right now:
- Emotional: I’m somewhere about midway along the spectrum. Anhedonia (inability to experience pleasure) is ever-present, but I’m pretty used to that by now. September was really bad mood-wise, but that’s improved this month.
- Cognitive: This is also about midway. My depression-induced slow brain was doing better for a while, but it’s started slowing down more lately.
- Perceptual: This is mild. I tend to be easily overstimulated when I’m depressed, but I’m really isolative, so stimulation is generally pretty minimal. Hallucinations have been an issue on rare occasions in the past, but not for quite a while.
- Disturbed view of self: This is pretty mild. I was having some issues with negative thoughts/feelings about myself last month, but it’s settled down now. I’m not feeling suicidal, but I’ve lacked the desire to live for quite a while. That’s more of a background issue than a foreground one, though.
- Physical: I’m towards the severe end on this one, at least in terms of the effects of my depression. Psychomotor retardation is an ongoing issue, and it’s had by far the greatest impact on my level of functioning out of any of my symptoms.
- Behavioural: I have turned into a full-on hermit. Dealing with other people in person is unpleasant and exhausting. Stress makes my psychomotor slowing worse, so I try to limit that as best as I can. Then there’s the anhedonia, so there’s no enjoyment in doing stuff. I feel best when I’m home with the guinea pigs, so that’s what I do. It works well for me, but it’s a substantial difference from how I would be living if I was not depressed.
Rainbow model functional domains
I think it’s really dismissive to refer to other people as high- or low-functioning, because real life is more complicated than that. Sometimes, functioning in one domain will pretty much completely shut down to divert resources to other areas. Someone might be able to manage working because they need the money, but everything else goes to shit. Someone might have high-functioning autism in the sense that they don’t have an intellectual disability, but occupational functioning might be totally off-line.
Different symptoms also have different degrees of impact on functioning. In the past, I’ve worked while feeling suicidal, but even moderate psychomotor slowing tends to shut down multiple functional domains.
These are the functional domains I’ve come up with or the rainbow model:
- Social: interpersonal interactions
- Occupational: work, volunteering, school
- Daily living: eating, hygiene, getting dressed
- Self-care: mental/physical/spiritual
- Health maintenance: seeing therapist/doctor, taking meds/supplements, routine physical health maintenance and labwork
- Meaningful activities: doing things that are important to you and give you a sense of purpose
Contrast this to the GAF
The DSM used to use a 5-axis system of diagnosis, which was done away with in the DSM-5. Axis 5 was for the Global Assessment of Functioning (GAF) scale. A score from 0 to 100 was given to quantify the level of functioning at the time of assessment. The GAF was anchored using a series of descriptors, which you can see in the copy of the GAF scale here.
The GAF considers functioning in terms of both functional domains and symptoms. Someone may be functioning well at work and thus appear overtly to be functioning well, but if they’re feeling highly suicidal, their functionality would rate low on the GAF. However, reducing it all down to a single number on a single scale seems pretty overly simplistic.
How I’m functioning
Here’s how I’m doing in terms of functioning:
- Social: My in-person socialization is limited to seeing my brother and niece every couple of weeks. I don’t have to try to mask at all, which is good, but if the visit goes longer than an hour I’m pretty wiped out afterwards. I get my social fix in the blogging world, which works well for me, but overall, I’d say I’m pretty impaired in this domain.
- Occupational: I’m low-functioning in this area. Work/volunteering is not doable at this point.
- Daily living: I’m somewhere in the middle on this. I’ve lowered my standards a lot, particularly when it comes to hygiene/grooming, but I am maintaining those standards. Lack of caring is the issue rather than lack of energy. Brushing teeth doesn’t happen very often; it’s very low down on the caring list. I seldom bother with cooking anything that requires much effort, but I go grocery shopping and I feed myself.
- Self-care: I’m pretty good about this. It’s fairly high on my priority list, which is easy enough since there’s no one else I need to look after. I get massages every two weeks, journal, snuggle with the piggies, use aromatherapy, and bird-watch in the courtyard.
- Health maintenance: As things got harder with COVID, I got worse with this. I want to find a new doctor, but currently, there’s nowhere nearby that’s taking new patients except walk-in clinics.
- Meaningful activities: I’m doing pretty well in this area, as this is where I’d slot blogging and writing. I choose to put it here rather than in occupational functioning because my brain isn’t sufficiently spontaneous in functioning to be able to write for anyone’s purposes or timelines but my own.
The bigger picture
Mental illness life is complicated. There can be a lot of different things going on, and a lot of things can change, sometimes abruptly. Trying to simplify too much risks losing sight of the person that’s underneath that high- or low-functioning label.
I hope this refined version of the rainbow model of mental illness functioning makes sense; I know I wasn’t all that clear when I explained it the first time around.
How well does this fit with how you conceptualize symptoms and functioning in your own illness?
My self care standards are not being maintained at the level they once were. Two showers a week have become one. I want to get back to two showers a week, so that I can improve other personal hygiene items. Thanks for sharing your updated model. I remember the first iteration last year. 🙂
Good luck with that goal!
Thank you!
this is great information! I would consider myself more closer to high-functioning (I go to work everyday, take care of C and get things done that need to get done) even though my symptoms tend to be in the mid to higher range. I’m a good hider of what’s going on for me and force myself to do things I don’t really have the energy/interest in doing.
I bet that can be both a good and a bad thing.
definitely
I very much relate to “I’m not feeling suicidal, but I’ve lacked the desire to live for quite a while.” That’s a hard one to explain to people who don’t have chronic illness.
I like the rainbow model very much: make sure you copyright that puppy. I like the way you separate symptom and function. It’s an important distinction many miss.
And your “how I’m doing,” – midway, midway, mild, mild, severe, and severe – is very much aggressively depressed. I’m sorry. Depression harms much. I’d wave my magic wand if I had one. 💖
Depression blows. Pain blows. But here we are, keeping on keeping on. ❤️
Right? We are serious rock stars! ✨
Woohoo, go us!
I like what you say about differentiating high and low functioning:
“Someone might have high-functioning autism in the sense that they don’t have an intellectual disability, but occupational functioning might be totally off-line.”
I can be pretty high functioning in my home but this does not always or almost never translates to occupational / work functioning. The choice and/or training of being a project manager is antithetical to what is needed for managing the bipolar condition.
My bipolar condition makes project management work feel completely overwhelming and not at all therapeutic. The project management work goes so far as to trigger my anxiety big time in that all aspects of the project must be managed well — on time, on budget and in scope. As a PM, you have to accept complete ownership of almost everything and 99% of that is outside of your control…. Influence yes, control no. Yikes!
That sounds like it would be super overwhelming!
Yes, indeed! For me it is a no brainer that I don’t need this type of work.
I understand this “model” – it’s clear and I would think quite useful for someone to get a handle on things. I don’t know if you would call this a metaphor but this I can understand and makes sense to me – (using tableware to describe anything but tableware makes me twitch – )
And I would imagine the term “spoonie” drives you up the wall…
And that means – what exactly?
Someone with a chronic illness who is chronically short on spoons. 😉🥄🥄
It fits with my experience of depression, where I was sometimes at work, but suicidal. It also fits with my experience on the autism spectrum, where I’m classed as ‘high functioning,’ but feel that I’m not that high functioning, and that that level of functionality is dependent on many other factors e.g. tiredness, environment, anxiety, etc.
To me it would make more sense to scrap the term high-functioning autism and just talk about people having or not having an intellectual disability. It seems rather unhelpful to suggest that everyone with autism who doesn’t have an intellectual disability is functioning well.
This chart you’ve designed is great. I would like to use it as a sort of mental “check-in” to see how I’m doing. When I’m in the right mindset to want to make progress of course, not at a time when I’m feeling too low.
Yeah, during the low times, reminders that things are shitty aren’t so helpful.
exactly
This resonates with me.
I love the rainbow model! I really can relate to how you said you aren’t necessarily suicidal but you don’t want to live. I feel that 110%. I would never do anything, but often times outside of my kids, I find my life meaningless.
It’s a tough place to be.
I’d want to adopt this for myself. Do you have pictures of it “in use” that I could see to better understand? ❤
Oh!!! I didn’t see the “in use” image in WP Resder but did when I opened your post in my browser. Sorry! ❤
i’ll put something together and email it to you.
My occupational functioning is next to zero, and I figure I can also use this for tracking a lot of the symptoms that affect my quality of life.
I’m at a zero there too.
It sounds silly maybe but you and Mio help my shame about occupational functioning more than my words can say. It’s humiliating for me to look at my similar aged peers since most work. And I face judgment and all that. But you two remind me without words that zero occupational functioning at whatever age doesn’t make me “worthless” whether I recover or not. In a society that does deem me worthless unless I recover to work again, when I get surprised looks from medical professionals when I say I can’t work consistency at my age.
I’m at zero most times but it’s a half truth to give myself some dignity… else I have to explain my functioning history and life history which I rather not…
You are definitely not worthless, and the people and society that try to shame you are the ones that suck.
💔❤💔❤
I love this so much, thanks for sharing it! I think it will be helpful for me to consider where I’m at with functioning, vs how I feel. Interesting!
Thanks!
So beautiful and resonant for me as someone who literally feels like moving rainbow energy :)) I only wish we could stop calling being human a “mental illness”. Because what you describe to me .. within my compassionate eye.. is just description of human spectrum of being and needs that require norishment. The pain that we feel to me is no illness – it is approriate response to the suffering and confusion human world has been for centuries